Yıl 2018, Cilt 8, Sayı 2, Sayfalar 103 - 110 2018-05-17

Epidemiology of post-operative complications in patients admitted to emergency service
Acil Servise Başvuran Hastalarda Post Operatif Komplikasyonların Epidemiyolojik İncelenmesi

İlyas Koç [1] , Mehmet Esen [2]

31 41

Aim: The aim of this study was to evaluate unplanned emergency room visits due to postoperative complications.The present study was to determine incidence rates of and clinic and laboratory causes of readmissions due to postoperative complications.

Materials and Methods: This prospective study included 300 of 640 patients who presented to Emergency Service of Gaziosmanpaşa University, Faculty of Medicine Hospital due to postoperative complications in May 2014 and April 2015 period. The data were recorded in the SPSS environment. Qualitative data were analyzed using Chi-square tests. Quantitative data were analyzed using one-way analysis of variance. Tukey test was used for multiple comparisons.

Results: The unplanned readmission rate is a nation-wide measure of hospital care outcomes. Of all 11,755 patients presenting to our emergency department, 640 applied for postoperative complications. Re-operation is associated with older age, high mean arterial pressure and recurrent emergency readmission. Average CRP was significantly higher in this group of patients admitted to the emergency service with postoperative complications for reoperation. These patients had wound infections (20.3%), hemorrhage-hematoma (10%) and pulmonary embolism (2.33%). The incidence rates for these conditions were higher than the rates reported in literature.

Conclusions: Patients with old age, comorbid diseases, elevated CRP and long hospitalizations should be discharged from hospital after they have been informed about the complications that may develop. Emergency care should be given more carefully to patients with recurrent readmissions because of their high morbidity and mortality rates. Taking necessary precautions will significantly reduce both cost and number of emergency service visits.

Amaç: Bu çalışmanın amacı postoperatif komplikasyonlara bağlı olarak planlanmamış acil servis ziyaretlerinin değerlendirilmesidir. Bu çalışmada  postoperatif komplikasyonlara bağlı klinik ve laboratuvar nedenler ve görülme oranlarını belirlendi.

Gereç ve Yöntem: Bu prospektif çalışmaya, Mayıs 2014 ve Nisan 2015 döneminde, postoperatif komplikasyonlar nedeniyle Gaziosmanpaşa Üniversitesi Tıp Fakültesi Hastanesi Acil Servisine başvuran 640 hastanın 300'ü dahil edildi. Veriler SPSS ortamında kaydedildi. Niteliksel veriler Ki-kare testleri kullanılarak analiz edildi. Nicel veriler, tek yönlü varyans analizi kullanılarak analiz edildi. Çoklu karşılaştırma için Tukey testi kullanıldı.

Sonuçlar: Planlanmamış yeniden kabul oranı, ülke çapında hastane bakım sonuçları ölçütüdür. Acil servisimize başvuran toplam 11755 hastadan 640'ı postoperatif komplikasyonlar için başvurdu. Tekrar operasyona alınma;  ileri yaş, yüksek ortalama arter basıncı ve tekrarlayan acil geri kabul ile ilişkilidir. Ameliyat sonrası komplikasyonlar nedeniyle acil servise birden çok başvuran bu grupta, ortalama CRP değeri anlamlı olarak yüksek bulundu. Bu hastalarda yara yeri enfeksiyonları (% 20.3), hemoraji-hematom (% 10) ve pulmoner emboli (% 2,33) vardı. Bu durumlar için insidans oranları literatürde bildirilen oranlardan daha yüksekti.

Sonuçlar: İlşeri yaş, komplikasyonlu hastalıklar, artmış CRP ve uzun yatışları olan hastalar, gelişebilecek komplikasyonlar hakkında bilgilendirildikten sonra hastaneden taburcu edilmeli. Yüksek morbidite ve mortalite oranlarından dolayı tekrarlayan başvuruları olan hastalara acil bakım dikkatle verilmelidir. Gerekli önlemlerin alınması hem maliyet hem de acil servis ziyaretlerinin sayısını önemli ölçüde azaltacaktır.

  • Association of periOperative Registered Nurses. (2012). AORN glossary of terms for principles to be used in evaluating allied health legislative. Retrieved from http://www.aorn.org/WorkArea/ DownloadAsset.aspx?id =22224
  • Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:14180–21428.
  • Kazaure HS, Roman SA, Sosa JA. Association of postdischarge complications with reoperation and mortality in general surgery. Arch Surg. 2012;147:1000–1007.
  • Kocher RP, Adashi EY. Hospital readmissions and the Affordable Care Act: paying for coordinated quality care. JAMA. 2011;306:1794–1795.
  • Centers for Medicare, Medicaid Services. Application of incentives to reduce avoidable readmissions to hospitals. Fed Regist. 2008;73:23673–23675.
  • Boccuti, C., Casillas, G. [updated September 20, 2016] Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program. 2017. Available from: http://kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program/
  • Minhas SV, Kester BS, Lovecchio FC, Bosco JA. Nationwide 30-Day Readmissions after Elective Orthopedic Surgery: Reasons and Implications. Journal for healthcare quality: official publication of the National Association for Healthcare Quality. 2017; 39(1):34–42.
  • Campbell KA, Stein S, Looze C, Bosco JA. Antibiotic stewardship in orthopaedic surgery: principles and practice. The Journal of the American Academy of Orthopaedic Surgeons. 2014; 22(12):772–81.
  • Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM. Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA : the journal of the American Medical Association. 2010; 303(24):2479–85. Epub 2010/06/24. DOI: 10.1001/jama.2010.841 [PubMed: 20571014]
  • Blom MC, Jonsson F, Landin-Olsson M, Ivarsson K. The proba¬bility of patients being admitted from the emergency depart¬ment is negatively correlated to in-hospital bed occupancy: a registry study. Int J Emerg Med 2014;7:8.
  • Sprivulis PC, Da Silva JA, Jacobs IG, Frazer AR, Jelinek GA. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust 2006;184:208-12.
  • Singer AJ, Thode HC Jr, Viccellio P, Pines JM. The association between length of emergency department boarding and mor¬tality. Acad Emerg Med 2011;18:1324-9.
  • Taylor C, Benger JR. Patient satisfaction in emergency medi¬cine. Emerg Med J 2004;21:528-32.
  • Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA. Association between waiting times and short term mortality and hospital admission after departure from emergency department: pop¬ulation based cohort study from Ontario, Canada. BMJ 2011; 342:d2983.
  • Geelhoed GC, de Klerk NH. Emergency department overcrowd¬ing, mortality and the 4-hour rule in Western Australia. Med J Aust 2012;196:122-6.
  • Readmissions Reduction Program. https://www.cms.gov/Medicare/medicare-fee-for-service-payment/acuteinpatientPPS/readmissions-reduction-program.html
  • Goldfield N, Kelly W, Patel K. Potentially Preventable Events: An Actionable Set of Measures for Linking Quality Improvement and Cost Savings. Q Manage Health Care. 2012;21(4):213–219
  • CMS. [January 7, 2017] Readmissions Reduction Program (HRRP). 2016. Available from: https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/ readmissions-reduction-program.html
  • Lawson EH, Ko CY, Louie R, et al. Linkage of a clinical surgical registry with Medicare inpatient claims data using indirect identifiers. Surgery. 2013;153:423–430.
  • Campbell DA, Englesbe MJ, Kubus JJ, et al. Accelerating the pace of surgical quality improvement: the power of hospital collaboration. Arch Surg. 2010;145:985–991.
  • Hall BL, Hamilton BH, Richards K, et al. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg. 2009;250:363–376.
  • Vonlanthen R, Slankamenac K, Breitenstein S and et al. The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg. 2011 Dec;254(6):907-13.
  • Vries EN, Prins HA, Crolla RMPH and et al. Effect of a Comprehensive Surgical Safety System on Patient Outcomes. N Engl J Med 2010; 363:1928-1937
  • Kirchhoff P, Clavien PA, Hahnloser D; Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010;25;4(1):5.
  • Kılıçaslan İ, Bozan H, Oktay C ve Göksu E. Türkiye’de Acil Servise Başvuran Hastaların Demografik Özellikleri. Turk J Emerg Med. 2005;5(1): 5-13
  • Özay HY, Bombacı E, Çobanoğlu G ve Çolakoğlu ES. Yoğun Bakım Ünitesine Tekrar Yatış Yapılan Olguların Geriye Dönük Analizi; Nedenleri, Sonuçları ve Mortaliteyi Etkileyen Faktörlerin Değerlendirilmesi. Türk Yoğun Bakım Derneği Dergisi 2012;10: 91-6
  • Hanna Misiołek H, Cettler M, Woroń J, Wordliczek J, Dobrogowski J, Zawadzka EM. The 2014 Guidelines for Post-operative pain management. Anaesthesiology Intensive Therapy 2014;46(4):221–244
  • Charlson ME, MacKenzie CR, Ales KL, Gold JP, Fairclough GF, Jr, Shires GT. The post-operative electrocardiogram and creatine kinase: implications for diagnosis of myocardial infarction after non-cardiac surgery. J Clin Epidemiol. 1989;42(1):25–34
  • Lawson EH, Louie R, Zingmond DS, et al. A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications. Ann Surg. 2012;256:973–981.
  • Hinami K, Bilimoria KY, Kallas PG and Simons, YM B.A, Christensen NP, Williams MV. Patient experiences after hospitalizations for elective surgery. The American Journal of Surgery 2014;207:855-862
  • Keenan PS, Normand SL, Lin Z, et al. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2008;1:29–37.
  • Verla T, Marky M, Farber H, et al. Impact of advancing age on post-operative complications of deep brain stimulation surgery for essential tremor. Journal of Clinical Neuroscience, 2015: 872–876
  • Statistics about Postoperative Hemorrhage. http://www.rightdiagnosis.com/p/ postoperative_hemorrhage/stats.htm
  • Perlino CA. Postoperative fever. Med Clin North Am. 2001 Sep;85(5):1141-9.
  • Jin Y, Xie G, Wang H, Jin L,Li J, Cheng B, Zhang K, Hoeft A, Fang X. Incidence and Risk Factors of Postoperative Pulmonary Complications in Noncardiac Chinese Patients: A Multicenter Observational Study in University Hospitals. BioMed Research International. 2015. http://dx.doi.org/10.1155/2015/265165
  • Lawson EH, Hall BL, Louie R, et al. Association between Occurrence of a Postoperative Complication and Readmission Implications for Quality Improvement and Cost Savings. Ann Surg 2013;258: 10–18
  • Cumming K, Hoyle GE, Hutchison JD, Soiza RL. Prevalence, Incidence and Etiology of Hyponatremia in Elderly Patients with Fragility Fractures. Ed: Terence J. Quinn. 2014 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3914945/pdf/pone.0088272.pdf
  • Tracie Gadler T, Gardiner A. Caring for the Postoperative Patient with Complications Presenting to the Emergency Department. Advanced Emergency Nursing Journal. 2014; 36(2):134–144
  • Greenblatt DY, Greenberg CC, Kind AJ, et al. Causes and implications of readmission after abdominal aortic aneurysm repair. Ann Surg. 2012;256:595–605.
  • Kassin MT, Owen RM, Perez SD, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;215:322–330.
  • Merkow RP, Hall LH, Cohen ME, et al. Validity and Feasibility of the American College of Surgeons Colectomy Composite Outcome Quality Measure. Annals of Surgery. March 2013;257(3):483–489
  • Ferraris VA, Bolanos M, Martin JT, et al. Identification of patients with PC who are at risk for failure to rescue. JAMA Surg. 2014;149(11):1103-8.
  • Carroll A, Dowling M. Discharge planning: communication, education and patient participation. Br J Nurs. 2007;16:882–886.
  • Clarke A. Readmission to hospital: a measure of quality or outcome? Qual Saf Health Care; 2004;13:10-1.
  • Howell S, Coory M, Martin J and Duckett S: Using routine inpatient data to identify patients at risk of hospital readmission. BMC Health Serv Res; 2009;9:96.
  • McHugh M, VanDyke K, McClelland M, Moss D. Improving patient flow and reducing emergency department crowding: a guide for hospitals [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2011 [cited 2016 Mar 7]. Available from: http://hsrc.himmelfarb.gwu.edu/cgi/viewcon-tent.cgi?article=1041&context=sphhs_policy_ facpubs.
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Konular Sağlık Bilimleri
Dergi Bölümü Orjinal Çalışma
Yazarlar

Orcid: 0000-0003-2180-6946
Yazar: İlyas Koç
Kurum: Uşak University, Training and Research Hospital, Department of Emergency Medicine
Ülke: Turkey


Orcid: 0000-0003-2180-6946
Yazar: Mehmet Esen (Sorumlu Yazar)
Kurum: Gaziosmanpaşa University, Faculty of Medicine, Department of Emergency Medicine
Ülke: Turkey


Bibtex @araştırma makalesi { gopctd412029, journal = {Journal of Contemporary Medicine}, issn = {}, eissn = {2146-6009}, address = {Selçuk Üniversitesi}, year = {2018}, volume = {8}, pages = {103 - 110}, doi = {10.16899/gopctd.412029}, title = {Epidemiology of post-operative complications in patients admitted to emergency service}, key = {cite}, author = {Koç, İlyas and Esen, Mehmet} }
APA Koç, İ , Esen, M . (2018). Epidemiology of post-operative complications in patients admitted to emergency service. Journal of Contemporary Medicine, 8 (2), 103-110. DOI: 10.16899/gopctd.412029
MLA Koç, İ , Esen, M . "Epidemiology of post-operative complications in patients admitted to emergency service". Journal of Contemporary Medicine 8 (2018): 103-110 <http://dergipark.gov.tr/gopctd/issue/27035/412029>
Chicago Koç, İ , Esen, M . "Epidemiology of post-operative complications in patients admitted to emergency service". Journal of Contemporary Medicine 8 (2018): 103-110
RIS TY - JOUR T1 - Epidemiology of post-operative complications in patients admitted to emergency service AU - İlyas Koç , Mehmet Esen Y1 - 2018 PY - 2018 N1 - doi: 10.16899/gopctd.412029 DO - 10.16899/gopctd.412029 T2 - Journal of Contemporary Medicine JF - Journal JO - JOR SP - 103 EP - 110 VL - 8 IS - 2 SN - -2146-6009 M3 - doi: 10.16899/gopctd.412029 UR - http://dx.doi.org/10.16899/gopctd.412029 Y2 - 2018 ER -
EndNote %0 Journal of Contemporary Medicine Epidemiology of post-operative complications in patients admitted to emergency service %A İlyas Koç , Mehmet Esen %T Epidemiology of post-operative complications in patients admitted to emergency service %D 2018 %J Journal of Contemporary Medicine %P -2146-6009 %V 8 %N 2 %R doi: 10.16899/gopctd.412029 %U 10.16899/gopctd.412029